Autonomic dysfunction and microvascular damage in systemic sclerosis

Abstract

Systemic sclerosis (SSc) is a connective tissue disease characterized by vascular damage and interstizial fibrosis of many organs. Our interest was focused on the evaluation of cardiac autonomic function by measurements of heart rate variability (HRV) and microvascular damage detected by nailfold capillaroscopy (NC) in SSc patients. We examined 25 consecutive outpatients affected by systemic sclerosis and 25 healthy controls. Exclusion criteria were the presence of cardiac disease, hypertension, diabetes mellitus, or neurological diseases. All subjects underwent 24-h ambulatory ECG Holter recording and NC examination. Heart rate variability was evaluated in the time domain, using appropriate software, computing the time series of all normal-to-normal (NN) QRS intervals throughout the 24-h recording period. A semiquantitative rating scale was adopted to score the NC abnormalities, as well as a rating system for avascular areas and morphological NC patterns. In SSc patients, HRV analysis showed significantly lower values of SDNN (standard deviation of all NN intervals) (p=0.009), SDANN (standard deviation of the averages of NN intervals in all 5-min segments of the entire recording) (p=0.01), and pNN50 (the percentage of adjacent NN intervals that differed by more than 50 ms) (p=0.02), compared to the control group. These parameters in SSc patients significantly decreased with the worsening of semiquantitative capillaroscopy score. In conclusion, an abnormal autonomic nervous control of the heart might contribute to identify subclinical cardiac involvement in SSc patients. The coexistence of autonomic dysfunction with a more severe microvascular damage could be considered a potential prognostic tool in the identification of those patients particularly at risk for cardiac mortality.

Systemic sclerosis impacts right heart and cardiac autonomic nervous system

“…Our findings confirm previous results regarding deterioration of cardiac autonomic nervous system in SSc patients . However, more interesting is the relationship between HRV indices and RV parameters (global strain, layer‐specific strain, and 3DE ejection fraction), as well as the association between Modified Rodnan Skin Score, HRV, and RV remodeling that have not been previously studied.…”

“…The involvement of the cardiac autonomic nervous system in SSc patients and its association with target organ damage has been previously reported . Heart rate variability (HRV) was used for noninvasive assessment of cardiac autonomic nervous system in most of these studies.…”

“…Heart rate variability (HRV) was used for noninvasive assessment of cardiac autonomic nervous system in most of these studies. HRV parameters that reflect both sympathetic and parasympathetic cardiac autonomic nervous system activity are affected by SSc …”

Sonography of the Nail

“…SSC can affect the microvascular structure and functionality of the nail unit; therefore, vascular abnormalities are common fi ndings in scleroderma. Other imaging modalities have been used to track the vascular changes in the nail such as laser Doppler, thermal imaging, and nail fold capillaroscopy [28][29][30] .…”

Anti-exudation effects of sodium ferulate and oxymatrine combination via modulation of aquaporin 1

“…The scoring criteria for the surface morphology of vascular endothelial cells were as follows: 0, no significant change of cell surface morphology; 1, large number of villi and few cellular edema; 2, loss of presudopodium and edema of various cells; 3, significant protrusion into the lumen and formation of a cell gap (13). The scoring criteria of damaged capillaries were as follows: 0, integrated capillaries with no significant damage; 1, mild damage but hardly any shedding of capillaries; 2, moderate damage with a small amount of capillaries shedding; 3, a large number of capillaries shedding (14).…”